Drewitz D J, Sampliner R E, Garewal H S
Section of Gastroenterology, Veterans Affairs Medical Center, Tucson, Arizona 85723, USA.
Am J Gastroenterol. 1997 Feb;92(2):212-5.
Barrett's esophagus is a premalignant condition defined by the presence of intestinal metaplasia in the esophagus. Estimates of the incidence of adenocarcinoma developing in patients with Barrett's esophagus vary widely. We prospectively followed a cohort of patients to define the incidence.
Between January 1982 and April 1995, all patients undergoing upper endoscopy at the VA Medical Center in Tucson, AZ, were surveyed for Barrett's esophagus. One hundred seventy-seven patients (174 males, three females) were found to have Barrett's esophagus. Seven of 177 were found to have adenocarcinoma either at initial endoscopy or within 6 months, resulting in a prevalence of 4%. One hundred seventy of 177 patients initially lacking cancer were available for systematic survey.
The mean age at the time of Barrett's diagnosis was 62 yr (range 30-85 yr). The mean follow-up period was 57 months or 4.8 yr (range 6-156 months), for a total of 834 patient-years. Adenocarcinoma developed in four patients, an incidence of 1/208 patient-years of follow-up.
The current series is larger and has a longer follow-up period than previous prospective trials and demonstrates a lower incidence of adenocarcinoma. Surveillance of patients with Barrett's esophagus for dysplasia remains an appropriate clinical practice.
巴雷特食管是一种由食管肠化生定义的癌前病变。巴雷特食管患者发生腺癌的发病率估计差异很大。我们对一组患者进行前瞻性随访以确定发病率。
1982年1月至1995年4月期间，对亚利桑那州图森市退伍军人医疗中心接受上消化道内镜检查的所有患者进行巴雷特食管调查。发现177例患者（174例男性，3例女性）患有巴雷特食管。177例中有7例在初次内镜检查时或6个月内被发现患有腺癌，患病率为4%。177例最初无癌症的患者中有170例可进行系统调查。
巴雷特食管诊断时的平均年龄为62岁（范围30 - 85岁）。平均随访期为57个月或4.8年（范围6 - 156个月），总计834患者年。4例患者发生腺癌，发病率为每随访208患者年1例。
与以往的前瞻性试验相比，本系列研究样本量更大，随访期更长，且显示腺癌发病率更低。对巴雷特食管患者进行发育异常监测仍然是一种合适的临床实践。
